Archive for June, 2011|Monthly archive page

I just read a ScienceNews article about another state legislature debating a soda tax. Illinois will (probably) not be taxing sugary drinks, at least partially due to a recent Northwestern University statistics study. The study showed that the tax won’t work because obese people drink diet soda.

As any reader knows, I’m death on sugary drinks, so this certainly caught my attention. It is an interesting study for a couple reasons. The most obvious point is that diet drinks don’t work. There have been a number of scientific studies showing that artificial sweeteners can make people eat more and are linked to obesity in general.

These stats just reinforce something most honest (ie., not paid by the food companies) doctors and nutritionists already know. What I was most struck by was the flawed assumption this smart, non-medical author made. Ketan Patel was quoted saying “obese people’s weight [won’t change] because they already drink diet soda.”

That is not the point! The kids who are growing up to be obese are the ones who need protected from sugary drinks. The young adult who is only 20 pounds overweight but headed for diabetes needs help avoiding the future. The mom who believes the lie that “Juice is good for you” needs help protecting her kids from the useless calories.

What a difference a day makes. Mrs. X was in the hospital a while back, admitted for her out-of-control diabetes. Her health had been declining for years with multiple complications caused by her weight and the diabetes it brought. I knew she was pretty miserable most of the time but this hospital stay was particularly bad.

Her feet burned from the nerve damage sugar can cause, her breath was constantly short because of the pressure on her heart and lungs, and this one morning even her mood and thinking seemed to be going bad.

We talked about how much trouble she was having at home just taking care of the basics. She admitted that she had let even those go in the days just before she was put in the hospital because she just felt too bad. I gently suggested that it might be time for her to be in a nursing home.

There the things that were getting too hard to do could be done for her. Even disoriented as she was I knew it hurt her to agree with me, but she did, saying she knew she had to.

I finished my exam, saw my other patients and then finished my charting while hoping to make it to the office in time for my first appointment. Just as I finished her chart, I saw the note her night nurse had written.

“Doctor, could Mrs. X see the diabetic educator? She said she would like that.”

Now I’ve known Mrs. X long enough to have sent her for education myself at least twice and had her tell me no another time or two. Every office visit for diabetes would sound the same.

“How have your home sugars been?”
“Pretty good, but sometimes I cheat a little and they get to 200.”
“Really? Hmm”

My ‘hmm’ was frustration because I know that sugars like she reported don’t match with the lab results I was getting. I had gotten her new a sugar tester, sent her for more education, even taken the slightly scary step of adjusting her insulin dose based on my numbers rather than hers.

Nothing would help for long. My goal had become helping her stay out of the hospital as much as possible rather than anything to do with her diabetes.

So when I walked in the next morning I was pretty surprised to find her sitting up straight, hair styled, eyes wide open and smiling. Did I have the wrong room?

“Well, you look better this morning,” I said, not sure what was in store for me.

“I know! I learned what I was doing wrong! The diabetes educator had to pretty much yell at me to get through, but I realized that you can only help me if I tell you the truth. So, I’m going to!” She beamed.

And that was that. That one little bit of understanding, that she and I were on the same team, that I’m not a cop or her boss, was all it took. To this day she has an outlook on life I’ve never seen from her. She counts calories and carbs, measures her sugars and helps me understand when they change with honest info about her diet.

Now she is steadily losing weight and feeling better. Best of all, now she how much her attitude and approach affect her health.

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Remember hearing this from your mom or the lunch lady growing up? It was usually said in accusatory tones, aimed at the Pepsi or Little Debbie I had added to my lunch tray.

You know what? Much as I hate to admit it, they were right!

Every piece and part of each of us is made of nothing but what we have eaten or drank over the last several years. Even though I can remember being me 5 years ago, 10 years ago, 30 years ago, I know that none of the ‘me’ now was part of the ‘me’ then. Kinda weird when I think about it too much, but it’s completely true.

The trillions of cells that make me are made of up billions of atoms. Every one of those atoms is replaced on a regular basis through my life. Guess what I’m making my cells of now? Let me tell you, I’m making much healthier choices than I made in high school and college. I’ve seen too much of the damage that poor eating habits cause and I want to avoid those health problems for myself.

The good news in all this is that it’s never too late to change. In a few years, you too can have an ‘all-new’ body, made from healthier stuff than ever. All it takes is a new outlook and new choices.

No doctoring for me today. Instead I got a reminder of what being a patient can be like.
Several weeks ago I read a news story on a new therapy for migraines. By finding and filtering out the color of light that triggers migraines, some people get relief.
Since I’ve been looking in vain for relief from my frequent migraines, often far from mainstream medicine, I immediately googled the Colorimeter the article mentioned.
The nearest optometrist with this fancy tool is 200 miles away? Sign me up!
I called Dr. Lederer that day and got an all-day appointment as soon as I could clear time in my schedule. Now here I sit in the waiting room, through with the first few hours of testing he recommended and waiting to hear the results.
Will it work? Can he help my head? Will the lenses he prescribes be pink? According to the article that started this odyssey for me, the most common color lens is yellow, with pink being next most common. Dr. Mary has been hoping I’ll come home wearing rose-colored glasses and I’m desperate enough to get rid of these #%¥| headaches that I’d wear them!
Dr. Lederer and his staff have been great, even as they put me through torturous eye calisthenics. Dr. Lederer is exactly the type you’d want as your doctor, energetic, excited, but down to earth about Internet cures. Bummer.
I was hoping he’d sell me some yellow-tinted glasses and I could be on my way back to Indiana before Chicago rush hour hits.
No such luck. Whichever way this works out for my eyes and head, it has done my mind and heart good to remember how foreign it all seems to the patient. My medical training is about useless in an optometrist’s office, so I have clueless sounding questions that I’m afraid to ask. I have no idea (and no warning) that one test will make me feel like I’m spinning and the next one make me wish I’d skipped breakfast.
A patient doctor with a kind and gentle staff goes a long way to calm this patient’s fears.
Thank you Dr. Lederer and Mary and Anne and Wendy and Kathy – you were all great. Here’s hoping it works!

Typical full morning schedule, a couple minor emergencies, a few cough-and-cold, and several follow up appointments for diabetes, hypertension, and cholesterol. These three run in a gang so often we should probably just invent a new word to save a few syllables. I think I’ll call it “Diacholsion”…

But what made it great was seeing progress. I love it when people actually start getting well and reducing their need to come see me and take my medicines. Today was one of those days that reminds me why I do this.

Four people in a row had lost weight and improved their blood chemistry numbers! Not just a pound or two either, but 10-15 pounds in 2-3 months. This is the perfect rate to prove a person has changed their lifestyle and eating choices.

Terry has cut out all red meat. Eating turkey instead has cut her calories and weight and improved her health and energy levels. Another lady is out working in her garden every evening and eating healthier since veggies are “always on my mind.”

The next patient had started Weight Watchers (my favorite program) with her husband. The competition between them to eat healthier, count their Points, and lose weight has made them both very motivated. She has lost over 12 pounds in just 6 weeks – great!

My final success story of the morning has been a while coming. We’ve talked over her choices, health, and weight every few months for the last 3 or 4 years. For her, watching a family member’s health get worse very quickly this spring has reminded her that life and health are precious. Sometimes the best motivator is a new outlook on life – she’s lost almost 10 pounds in 2 months and knows her changed food choices are the reason.

Ain’t progress wonderful! Cheer these women on and take their stories as inspiration if you’re short on your own. We all need a little motivation boost from time to time. These folks each have different backgrounds, goals, ages, and health. What they all have in common is an eye on the goal and the know-how to get there.

He grinned. “Well, I’m not saying you were right, but peanut butter does make a heck of a breakfast.”

Excellent! I really like this guy. He’s funny, down-to-earth, and brutally honest. Telling him he had diabetes 6 months ago was hard and he took it pretty rough. Like many of us, diabetes is “all in the family” and I could almost see the memories coming up for him when I told him he had crossed the line from pre-diabetes to diabetes.

Maybe an uncle that lost a leg? A great-aunt gone blind? A scary childhood flashback of watching grandma collapse into a ‘sugar coma’?

Whatever his fears, he perked up the moment I told him “You can fix this.” I had told him that before, but something got through a little deeper this time. I knew he meant it when he said, “I’m gonna.”

Now here we are, 6 months later. He has lost over 15 pounds and his sugar is down into the normal range. I love that moment of realization when my patient knows, really knows, that their health is up to them. This was the moment for him and he made it a great moment for me, too.

“All I’m doing is what you said.” He ticked them off on fingers. “One. Peanut butter on a spoon for breakfast. Two, I reach for an apple instead of the chips. Three, I don’t eat white. Easy.” Queue the big grins and high fives!

Convenience is great. I love the ease of driving through the car wash, waving my credit card, and driving away with a sparkling car. At least until I get the bill. Then I think “Couldn’t I have washed it myself and saved that $15?”

We can find companies willing to do most things in life for us now. House cleaners and lawn care services and snow removal companies are great time savers. I stopped sweating over changing my own oil a few years ago. The car I drove required a $150+ wrench to remove the oil filter and I couldn’t see buying it. It was so convenient I never went back even after trading cars. I’ve seen ads for professional organizers, party planners, and even dog-poop-scoopers.

One of the conveniences Americans use the most is also one of the worst for our health, though. Having someone ‘pick up after’ our two dogs isn’t likely to make me need bigger pants. Eating out for lunch? Stretchy pants are definitely on the radar.

I started bringing my lunch years ago when I was a medical student and too poor to even buy food from the clown in the hospital. (The Riley Children’s Hospital in Indianapolis has a freakin’ McDonald’s in the lobby!) I’ve kept it up all these years, now mostly to avoid eating the stuff that everyone else in the office has to put up with for lunch. Fried chicken dinner from the gas station convenience store or pork tenderloin sandwich from the greasy spoon diner? Tough choices, huh? Even the ‘Jared-approved’ Subway run seems to lead to too many calories too easily.

I think the control over my lunch-time is well worth the time it takes to plan ahead and have my lunch with me. Ten minutes are all it takes – try it! Besides, just think of all those $5 lunch bills going back into your pocket if you need any further motivation.

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I wrote about Dr Henry Cloud several posts ago and want to return to his powerful writing and thinking about personal development.

In his book 9 Things You Simply Must Do, Dr. Cloud describes a life lesson he learned watching an ant farm. Each ant carried a single grain of sand, doing what seemed a tiny, almost meaningless amount of work. But as ants do, they kept at it, eventually building an entire ant city, with tunnels, streets, and rooms. One grain at a time!

Dr. Cloud was so struck by the comparison that he says it changed his entire view of things. Tiny steps, so small they were easy to ignore, built a city. But without the tiny steps, there would have been just a sand pile instead of an ant metropolis.

The same principle applies to all of life, he says. The small, steady steps are what leads to changed lives and improved health. Know why crash diets never work in the long haul? Because skipping the small, steady steps of adopting a healthy lifestyle and trying to ‘cheat’ the body and force rapid weight loss hasn’t really changed anything.

A person that is too impatient for change skips the steps that lead to new habits and easier self-control. Without these changes, weight loss (or any other health improvement), won’t last.

The whole world hinges on small, steady changes. Snowdrifts don’t just appear, they grow one flake at a time. An oak tree comes from an acorn by countless tiny steps, a high school kid doesn’t just ‘become’ a doctor, and complicated machines like a computer don’t just happen.

We could all come up with dozens of other examples like this, because deep down, we all know this is how the world works.

Somehow, between microwaves and McDonald’s we have forgotten that our bodies change this same way. Nobody goes to bed thin, strong, and healthy and wakes the next morning obese and sick. Why would anyone expect the opposite?

Being healthy or not is most often the result of years of tiny, seemingly insignificant choices and actions. Apple or donut? Couch or bike? Stairs or elevator? Coke or water?

One choice, one grain at a time, we are building our future selves. Are you building a city or a sand pile?

Some days it comes home harder than others – today was one of the harder days. Patient after patient this morning looking to me for help in feeling better, not so unusual. What was hard and thankfully not as usual was how many of them have gotten themselves into their own jam.

No one can ignore their health, be a couch potato, and eat like an American and not end up feeling the effects. Today, the effects were on parade in my office. Diabetes gone bad, hearts giving out from the strain, emphysema to the point that an oxygen canister won’t help – hard stuff.

Not a one of these folks is a bad person. I like each and every one, which makes it even harder to watch them suffer and know I can’t do much more than tweak. Adjust something here, recommend something there, but all told, not much.

The only person who can help them is themselves. It just seems like such a habit not to help themselves that they can’t imagine changing. I’ve seen people change and know it’s possible, so I’ll continue to be their cheerleader (or drill sergeant, depending on who you ask.) I guess some days this cheerleader gets a little hoarse

On the bright side, it is an amazing day here in Indiana. Enjoy summer wherever you are and treat yourself right!